prescription drug impact in the workplace tess benham, sr. program manager, national safety...
DESCRIPTION
Learning Objectives Understand the impact of prescription drug abuse on Indiana businesses and workplaces. Identify strategies for educating your workforce. Identify challenges to and resources for implementing a prescription drug abuse training program in your workplace.TRANSCRIPT
Prescription Drug Impact in the Workplace
Tess Benham, Sr. Program Manager, National Safety CouncilDr. Denise Fields, PharmD, Sr. Clinical Consultant, Express ScriptsTamara Watson, Master Trooper, Indiana State Police
Conflicts of Interest
• Tess Benham has no conflicts of interest to disclose.
• Dr. Denise Fields is an employee of Express Scripts, but this will not influence today’s presentation.
• Master Trooper Tamara Watson has no conflicts of interest to disclose
Learning Objectives
• Understand the impact of prescription drug abuse on Indiana businesses and workplaces.
• Identify strategies for educating your workforce.• Identify challenges to and resources for
implementing a prescription drug abuse training program in your workplace.
Results from aSurvey of Indiana Employers
Setting the Stage
Tess Benham, Senior Program Manager, National Safety Council
Overall Objectives:
The purpose of this research was to understand current attitudes and behaviors around prescription drug policies and procedures among Indiana employer
Methodology:
Online survey invitations were sent to HR and safety professionals.
Sample:
Sample was a combination of NSC contacts and SHRM members in Indiana.
Timing:
Survey was fielded May 13th through August 20th, 2015.
Survey Background
Survey Background (continued)
Qualified Respondents:
• 50+ total employees in organization/company (all locations)
• Make or share in determining organization practices for hiring practices, training, benefits programs or employee policy
Statistical Significance:
• Results analyzed at the 95% level of confidence
• Margin of error, +/- 6.9%
50 to 99 employees
100 to 499 employees
500 to 1,000 employees
Over 1,000 employees
11%
42%
11%
36%
# of Employees Job Title/Role
(n=201- Total)
Participant Demographics
S1 How many employees work in your organization or company, taking into account all units and locations? (Your best estimate is fine)
29. Which of the following best reflects your job title?
(n=201- Total)
Human Resources
Environmental Health Safety
Risk Manager
Training & Staff Development
Owner or CEO
Other
56%
23%
5%
5%
4%
7%
Manufacturing
Health Care and Social Assistance
Transportation and Warehousing
Finance and Insurance
Construction
Professional, Scientific, and Technical Services
Educational Services
Retail Trade
Utilities
39%
11%
10%
6%
5%
5%
5%
3%
3%
Industry
(n=201- Total)
Participant Demographics (continued)
Arts, Entertainment, and Recreation
Wholesale Trade
Mining, Quarrying, and Oil and Gas Ex-traction
Public Administration
Real Estate and Rental and Leasing
Agriculture, Forestry, Fishing, and Hunting
Information
Accommodation and Food Services
Waste Management and Remediation Services
2%
2%
2%
2%
2%
1%
1%
0.5%
0.5%
32. Which of the following categories best represents the industry to which your company or business unit belongs?
(n=201- Total)
Participant Demographics (continued)
36. Where is your headquarter location located?30. If applicable, how many years have you worked in your field?34. Are any of your employees covered by union regulations or contracts?
79% have HQ in Indiana
77% in their field 10+ years
71% have no emp. covered by union regs or contracts
68% senior-most for location or organization
65+ have employees at multiple locations
31. Which statement best describes your personal level of responsibility within your organization for health and safety issues?
35. Do most employees at your organization work…?
(n=201 - Total)
Scope of the Problem
Observed an Issue (NET)
Use of Rx painkillers at work
Positive drug tests result for prescription
Absenteeism or missed work
Family member affected
Impaired/ decreased job performance
Borrowing or selling Rx drugs at work
Complaints to HR/ negative morale
Near miss or injury related to Rx drug usage
Arrest (on/off job)
Overdose
None
80%
59%
41%
41%
40%
35%
23%
19%
19%
10%
5%
20%
Observed Workplace Issues
6. Keeping in mind that all information will be kept strictly confidential, which of the following are you aware of having occurred in your workforce? Please include any occurrence, even if it is few in number.
(n=201- Total)
Most Indiana comp. impacted by RX abuse…
Justifiable reason to fire
Bigger problem than illegal drugs
Harming safety
Moral/ ethical failure
Lowering productivity
Is a problem
Decreasing morale
Causing near misses or injuries
Making it hard to hire
Increasing Worker’s Comp.
Making it hard for keep
39%
18%
14%
16%
12%
11%
5%
6%
6%
5%
3%
37%
46%
32%
29%
32%
28%
26%
24%
23%
23%
18%
Strongly Somewhat
Agreement with Statements
5. Please rate your agreement with each of the following statements about the impact of prescription drugs on your organization. Misuse or abuse of prescription drugs is…?
76%
% Strongly/Somewhat
64%
46%
45%
44%
39%
31%
30%
39%
28%
21%(n=201- Total)
… and feel it is a problem…
Ability to hire Benefits Costs Aging of the workforce
Worker comp / costs
Illness / absen-teeism
RX drug misuse
Illegal drugs Workplace violence
74% 68%51% 46% 42%
29% 25% 23%
Major Concern
Level of Concern - Issues
1. How concerned are you about the impact each of the following issues may have on your organization?(n=201- Total)
…but everyday concerns eclipse the problem.
Agreement with Statements
5. Please rate your agreement with each of the following statements about the impact of prescription drugs on your organization. Misuse or abuse of prescription drugs is…?(n=201- Total)
Underlying beliefs a barrier to org. change.
76%
24%
45%55%
… a justifiable reason to fire an employee. …a moral or ethical failure.
AgreeDo not agree
Behaviors of Indiana Employers
Topics Covered by Organizations Written Policy
10. Which of the following topics are specifically covered in your organization’s written policies?
None of these
Drug testing
Employee use of drugs without a prescription
Return to work policies for employees undergoing substance abuse treatment
Employee use of prescription drugs at work
Employee responsibility to notify supervisors of prescription drug usage
Performance improvement plan for employees who have failed drug tests or whose performance has declined related to drug
usage
Unsure/Don’t know
5%
84%
60%
58%
53%
48%
34%
4%
(n=201- Total)
Most cover drug tests, but few address abuse.
Policy Best Practices
• Address non-medical use of prescription and over-the-counter medications in the policy
• Include prescription medications in drug testing panel and policy
• Provide guidance to employees on when it is okay to use medication at work and if they should report this use
• Be able to assign employees to alternate work tasks while on medication
• Provide information about how to access employee benefit and assistance programs
Most conduct drug testing…
Yes (NET)
Pre-employment
When need is indicated
At random intervals
On a fixed schedule
No
87%
79%
63%
39%
3%
13%
Conduct Drug Testing
20. Does your organization require drug testing for your employees?
(n=201- Total)
22. What substances are tested for?
Substances Tested For
Cannabinoids (Marijuana, THC)
Opiates (Codeine, Morphine, Heroin)
Amphetamines (including Methamphetamine) (Adderall, Ritalin, etc.)
Cocaine
Barbiturates (Seconal, phenobarbital, etc.)
Benzodiazepines (Xanax, Ativan, Klonopin, Valium, etc.)
Phencyclidine (PCP)
Methadone
Synthetic Opioids (Oxycodone, Hydrocodone, Dilaudid, Fentanyl, etc.)
Methaqualone (Quaaludes)
Propoxyphene
Other
Don’t Know/Not Sure
93%
91%
91%
91%
77%
64%
61%
57%
52%
43%
31%
11%
26%(n=174- Require Drug Testing)
…but few test for opioids…
…the most frequently abused drug in Indiana.
Upon admission to treatment in Indiana, top drugs of choice reported are:• Alcohol• Opioids• Polysubstance abuse
• Opioids• Cannabis• Benzodiazepines• Alcohol
Yes (net)
Annonymously assist
Develop plan to assess/ treat
Identify employees with abuse issues
Other
No
87%
79%
29%
12%
3%
12%
Use Employee Assistance Program (EAP)
18. How confident are you in your EAP providers’ ability to handle substance use, misuse or abuse issues?
Level of Usage of EAP
Increasing Staying the same Decreasing
22%
76%
2%
(n=201- Total) (n=176- Have EAP)
Most take advantage of an EAP.
19. s that rating based upon…?
9. Which of the following, would you say, best reflects your organization’s approach to an employee who is found to be misusing or abusing drugs or alcohol?
Organizational Approach to Employee Misuse/Abuse of Drugs or Alcohol
63%
33%
2% 1% 1%
(n=201- Total)
Most want to return employees to work...
HR Supervisors Employees
38%35%
26%
Very Confident can Identify Warning Signs
8. How confident are you that your Human Resources department, supervisors and employees can correctly identify behavior that is a warning sign of misuse or abuse of prescription medication?
(n=201- Total)
…but can’t identify who needs help...
…because very few offer any training.
Offer Training
11. Does your organization currently offer training around workplace usage of prescription drugs?
Do not Train; 71%Train; 29%
(n=201- Total)
• 29% train supervisors• 13% also train employees
Prescription for Indiana Employers
1. Recognize prescription drugs have big impact on your workplace
2. Put strong policies in place
3. Expand drug testing panels to include opioids
4. Train supervisors and employees how to spot signs
5. Treat substance use problems as a disease
6. Leverage EAP to assist employees to return to work
Strategies for Training your Workforce
Dr. Denise Fields, PharmD, Senior Clinical Consultant,
Express Scripts
Tamara Watson,Master Trooper,
Indiana State Police
Where to start
Forming your team
Identifying your resources
Developing policies and procedures
Engaging employees in awareness and education
Forming your team
Internal
Executive leaders
Labor relations
Legal
Human Resources
Benefit leaders
Facilities
Safety/Risk Management
External
Clinical Experts
Law Enforcement
Community Resources
Health/wellness vendors
Identifying your resources
Do you know or have clinical experts, community leaders, vendors or law enforcement contacts that would be willing
to volunteer/assist?
Can you get approval to pay employees for an hour of non-
productive time?
How is your benefit plan for employees
designed?
Developing Policies and Procedures
Company Stance Drug Testing Disciplinary
Action
Law Enforcement Relationship
Benefit Design
Medication Security
Safety & Risks Education & Training
Engaging employees
• General awareness education can be an early/initial activity, even as policies are still being developed.
• Consider when and how often general awareness education should be done:• Onboarding• Annually or semi-annually• When an event occurs
Awareness effort considerations
Who will be educating your workforce?
Who should your audience be?
What content should be included?
What presentation style will work best?
Who should educate your population?
Clinical
• Physician• Pharmacist• Paramedic/First Responders
Community
• Law Enforcement• Local Coordinating Council
Vendors
• Employee Assistance Program (EAP)• Health and Wellness Partners
Consider your audience
• Create different education programs for your management/supervisory level employees from your general pool of employees
• Consider not having management present at your general employee meetings
• Educate your audience not only as employees in a work setting, but also touch on effects of Rx Drug Abuse on their community and family
Presentation Delivery
• Make it interactive– Use audience polling questions/system– Incorporate games or competitions
• Remain non-judgmental• Ensure it is relatable
– Use real life examples– Tie it in to community or workplace
Have you ever heard or said…..
“Just take a few of my leftover…”“My sister will never miss one or two of these, and I have a
huge headache…”“I was just borrowing a couple of pills from an old bottle of
medicine in the cabinet...” “I store all these in case someone needs them
sometime…”“Dad will never notice they are gone...”“We just have not had time to go through all these drugs
since grandpa passed away…”
What to include
Why are prescription drugs an addiction issue?
What are the signs and symptoms?
What are some issues specific to the workplace?
What resources are available?
What are the potential legal ramifications?
Why Prescription Drugs?
• Provide statistics on Prescription Drug Abuse– Compare US vs state vs county/local statistics– Review statistics available for specific job types
• Describe some of the cultural/social drivers• Explain the supply chain• Describe the business plan
Reasons Adults Abuse Drugs
Pressure to Succeed or meet a deadline
Desire to Fit In
Death of a Loved One
Job LossDivorce
CARING FOR AN AGING PARENT OR DISABLED CHILD
Why Pharmaceuticals?
• Easy to obtain• Cost effective – especially with insurance!• Perceived as safer• Easier to conceal• Generally odorless• Dosage Consistency• Everyone’s doing it!
Recognizing the signs and symptoms
– Describe the physical and emotional signs/symptoms employees could exhibit
– Explain the focus for disciplinary action(s) should be on job performance
• Reinforce that supervisors, managers and co-workers should not attempt to diagnose
– Gives examples of physical evidence left behind– Review slang words or terms related to Rx drug abuse– Educate supervisors/managers regarding drug testing
limitations• Qualitative vs quantitative testing• What does a preliminary “non-negative” result mean?
Job performance issue examples
• Reduced productivity or work quality• Absenteeism and tardiness• Bizarre and/or disruptive behavior• Concentration problems• Erratic work habits• Concerns about possible substance use• Interpersonal conflicts; confrontations with coworkers
and/or customers• Violence at home or at work, including threats of suicide
or workplace violence
Supervisor Guidelines
• Know your employer policies and procedures• Be aware of legally sensitive areas• Recognize potential problems• Document in a systematic and fair manner• Act in a confidential manner• Refer to appropriate resources• Reintegration into the workplace
Work place specific issues
• Company policy and procedures– Drug testing– Disciplinary action
• Dangers in the workplace– Safety risks– Financial risks– Corporate brand/image risks
• Security of medications at work
Resources available
National Experts
• SAMHSA• National Safety Council• Centers for Disease Control (CDC)• National Institute on Drug Abuse
Community
• Law Enforcement• Church programs• Social workers/Support groups• Healthcare facilities/providers
Vendors
• Employee Assistance Program (EAP)• Pharmacy Benefit Manager (PBM)
Legal Ramifications
– Relationship with law enforcement– Perpetrator and victim can be same person– Legal vs not legal activities– Felonies vs misdeamoners– Felony Impact
Felony Consequence Examples• Disenfranchisement (expressly permitted by the Fourteenth Amendment, as
noted by the Supreme Court)….”losing your right to vote”• Exclusion from obtaining certain licenses, such as a visa, or professional
licenses required to legally operate (making some vocations off-limits to felons)• Exclusion from purchase and possession of firearms, ammunition, and body
armor• Ineligibility to serve on a jury• Ineligibility for government assistance or welfare, including being barred from
federally funded housing• Deportation (if not a citizen)• It is legal to discriminate against felons in hiring decisions as well as the
decision to rent housing to a person, so felons can face barriers to finding both jobs and housing
• Many banks refuse service to convicted felons• Some states consider a felony conviction grounds for an uncontested divorce
Challenges and Opportunities
• Awareness and Education• Outdated/insufficient data in the workplace• Outdated DOT testing panels• Access to Care – Local resources• Changing your benefit plan (make physical therapy
more convenient and just as cheap as a $4 Rx)• Lifestyle education to equip and motivate
employees to make better lifestyle choices (so that they don’t need medications)
Resources
• National Safety Council – www.nsc.org/rxpainkillers
• NSC Prescription Drug Employer Kit– www.nsc.org/rxemployerpolicy
• Bitter Pill– www.in.gov/bitterpill/workplace-risks.html
• Department of Labor E-Laws Drug Free Workplace Advisor– http://www.dol.gov/elaws/drugfree.htm
Learn more at BitterPill.IN.gov
Thank you
Questions…